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Squeezed between increasing expenses and decreasing insurance payments, independent doctor practices are looking to larger organizations to relieve the pressure, be it a hospital or a mega-practice.

Central Ohio Primary Care Physicians Inc. has added five practices this year, up from a usual clip of two or three, said CEO Tom Bishop. The group, which started with 33 physicians in nine practices in 1996, has grown to 170 doctors in 39 practices, with 1,000 employees and 250,000 active patients.

"The smaller practices are just having more and more problems competing," said Dr. Craig Anderson, a Columbus neonatologist and president of the Ohio State Medical Association, the trade group for doctors. "They go to school to take care of patients and not to run a business."

Specialists are more likely to join a hospital staff, he said, while primary care doctors, such as internal medicine specialists and pediatricians, are more likely to consolidate.

Central Ohio Primary Care doesn't solicit practices to join, Bishop said. Only one member is a practice the group founded.

"We had a lot of physicians approach us and say, 'I'm really tired of being independent,' " he said.

Arlington-Mill Run Internal Medicine LLP in Hilliard was in talks to found the practice 11 years ago, but stayed on its own until six months ago, said Dr. Steven Lichtblau, senior partner.

"We wanted to sit back and watch and see how they did," he said.

While Arlington-Mill Run could have survived on its own, its doctors wanted to gain the advantages from the larger group.

"We do keep our name and we do keep our practice locations," Lichtblau said. "We do the things in our practice we want to do."

"All the lab work I do today," he said, "will be on my desk tomorrow morning."

Central Ohio Primary Care is nearly halfway through converting to electronic medical records and should finish the project in 2009, Bishop said. A 12-person scanning and indexing team is inputting the most relevant documents from patient records, and the practices add information electronically.

"It's nice to be part of a group that has tried it," Lichtblau said. "By the time we get around to doing it, they should have it all perfected for us."

Also, except for the pediatricians, member doctors no longer must make hospital rounds before or after office hours because the practice includes a group of 21 doctors who are on around-the-clock call for Central Ohio Primary Care patients.

The offices are mostly clustered near Mount Carmel East and St. Ann's hospitals and OhioHealth Corp.'s Riverside Methodist Hospital.

This year's acquisitions, however, expanded the practice's geographic reach. That included the first practice on the south side of Columbus at Parsons Avenue Medical Clinic. In October it added its second practice in Union County at Marysville Primary Care.

"I think Marysville is going to be a growth area for our company in the future," Bishop said.

The practice also could expand into other counties neighboring Franklin County.

The other additions were Family Physicians of Gahanna Inc. and the Upper Arlington practice of Drs. Robert K. May, J. Thomas Broyles and Christen Coyle.

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